Never ignore rectal bleeding

"Why didn't you come to see me earlier? It could have saved you months of worry," I recently asked a patient.

She had rectal bleeding and delayed seeing me because she was terrified I'd tell her the diagnosis was cancer. Yet, her only problem was anusitis, an often overlooked rectal condition. But whether it's anusitis or a serious problem the cardinal rule is never, never ignore rectal bleeding.

Many people think rectal bleeding means they're suffering from hemorrhoids, but the cause is often anusitis, an inflamed area just inside the anus, which causes a burning sensation, discharge and wetness. This results in multiple tiny cracks that trigger itching.

For many, relief is as close as the refrigerator door. For years doctors have used cold therapy (cryosurgery) to relieve the swelling and pain of sport injuries, but until recently no one thought to use cryosurgery to treat rectal problems.

Anurex is one of the best kept secrets for this condition. It's a reusable probe containing a gel that's gently inserted into the rectum after being cooled in the freezer for at least one hour. The probe is left in the rectum for six minutes, removed, washed and returned to the freezer.

Cooling of the anal area quickly reduces local blood flow, inflammation and swelling. This in turn relieves irritation, discharge and bleeding.

Anurex has a great track record. At the Rudd Clinic in Toronto in a series of 220 patients, 90% were relieved of their symptoms within one to two days.

Anurex is used twice a day for two weeks, then once a day for another two weeks. Patients can then use it as needed. It's also useful for pregnant women and it's "drug free," a great benefit these days.

If the diagnosis is hemorrhoids, fewer cases today are being treated by surgical removal. Rather, doctors place a tiny rubber band around the base of the hemorrhoid and then use cryosurgery to freeze it.

The rubber band shuts off the blood supply to the hemorrhoid and several days later the pile drops off. This leaves a raw area that takes two to three weeks to heal. Most patients require two to three visits to destroy all the hemorrhoids.

Unfortunately, not all cases of rectal bleeding have such a good outcome. An article in The British Journal of Medicine shows that less than half of those with rectal bleeding sought medical advice. This is tragic if the problem is cancer.

Today malignancy of the large bowel is the second leading cause of cancer deaths in North America. But unlike malignancies of the ovaries and pancreas which are hard to diagnose, it's possible to detect and remove polyps in the colon by colonoscopy long before they become malignant. Ideally by age 40 everyone should have this procedure done.

Inflammatory bowel disease (IBS) is another cause of rectal bleeding also associated with abdominal pain, fever, weight loss and diarrhea.

Some patients suffer from ulcerative colitis, an inflammation of the inner lining of the large bowel and rectum. Others have a condition called Crohn's Disease in which the inflammation extends deeper into the intestinal wall and often affects both small and large bowel. The early diagnosis and treatment of IBS can help ease its progression.

Due to an aging population, more patients are developing diverticulosis, small hernias of the large bowel. Diverticulosis is often associated with a long-standing history of constipation due to a low fibre diet. These pouches are often without symptoms, but in 15%-40% of cases painless bleeding occurs. If these hernias become inflamed there's also abdominal pain and fever. And should one of these pouches rupture, an emergency operation is needed.

The good news is that rectal bleeding is usually the result of minor problems such as anusitis and hemorrhoids. But patients who assume this is the case are playing a dangerous game of Russian roulette. The only safe approach is to quickly see your doctor.